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The editorial urging flu shots for anyone working in a hospital or other health care institution comes just days after Health Canada asked vaccine supplier Novartis to suspend distribution of two of its flu vaccines, Agriflu and Fluad, because of floating white protein material discovered clumping in vaccines.

Photograph by: Joe Raedle
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OTTAWA – Doctors who refuse to get a flu shot are inadvertently increasing the risk of their patients dying of flu, argues an editorial in Canada’s top medical journal that calls for mandatory flu shots for health care workers.

“No right-thinking physician would ever knowingly harm a patient or fail to do something essential that would result in harm to a patient,” Dr. Ken Flegel, senior associate editor of the Canadian Medical Association Journal writes in an editorial published Monday.

“This principle of medical practice is enshrined in the Latin dictum primum non nocere (first do no harm),” Flegel said.

“But when 55 per cent to 65 per cent of physicians fail to take the annual seasonal influenza vaccine they are exposing their patients to the risk of death from influenza.”

The editorial urging flu shots for anyone working in a hospital or other health care institution comes just days after Health Canada asked vaccine supplier Novartis to suspend distribution of two of its flu vaccines, Agriflu and Fluad, because of floating white protein material discovered clumping in vaccines.

That kind of clumping is common in vaccines, the agency said in a release, adding that it has seen no impact on safety or effectiveness. However, as a precautionary step, the vaccines produced by Novartis have been pulled from use pending a full review, Health Canada said.

Flegel said that, if anything, the move should increase public confidence in the safety of flu vaccines, saying that the government is being extra cautious and “prudent” in removing a part of the flu vaccine supply “that’s apparently not perfect.”

“It’s just got a slight impurity, it’s not a big deal,” said Flegel, a professor of medicine at McGill University in Montreal.

“A protein that is in every vaccine has come out of the solution. It’s like getting a sugary drink that had too much sugar put in it so there are still some sugar grains in the bottom. Nobody would be worried about drinking that drink.”

In Canada, flu accounts for about 20,000 admissions to hospital each year, and between 4,000 and 8,000 deaths. “A goodly proportion (of those deaths) happen in hospital, and, of those deaths, another goodly proportion are acquired in hospital,” Flegel said.

“I think some physicians will not be aware that they actually are instrumental in increasing the rate of in-hospital deaths (from influenza) by failing” to get immunized, he said.

He argues that flu shots for health workers should be compulsory, although exemptions could be granted for medical reasons or for “deeply held religious or philosophical convictions.” However, buy-in would need to be above 90 per cent “to prevent (flu) importation and to interrupt transmission within a hospital.”

“We’re recommending that each health care institution devise their own program and suggesting that there’s room for special cases, but they have to be limited,” Flegel said.

Each season, 20 per cent of health care workers get influenza, Flegel writes in the CMAJ.

Ontario’s public health agency is recommending that the annual flu vaccination should be a condition of employment in health care institutions.

In British Columbia, new regulations will require health care workers to get flu shots or wear masks when treating patients.

But Flegel said that about 58 per cent of young adults who get flu have mild symptoms or none at all. Some are capable of shedding the virus a day before they get symptoms.

“Asking people to go home when they’re sick is not going to afford the same protection as asking them to be immunized before the flu season.”

He said compulsory flu-shot programs in Philadelphia-area teaching hospitals have resulted in participation rates above 95 per cent.

“Compulsory vaccination may be regarded as ethically questionable because it violates a person’s autonomy,” Flegel writes in the CMAJ. But he said the interest of patients must come before the interest of health care workers.

Evidence from four randomized controlled trials — “which is the top of the line evidence” — showed a five to 20 per cent reduction in deaths during flu season among residents in chronic care institutions where staff vaccination rates were 51 to 70 per cent.

“Most patients in acute care hospitals are sicker than the ones in these studies and less able to resist a new infection or mount an immune response,” Flegel said.

The editorial urging flu shots for anyone working in a hospital or other health care institution comes just days after Health Canada asked vaccine supplier Novartis to suspend distribution of two of its flu vaccines, Agriflu and Fluad, because of floating white protein material discovered clumping in vaccines.

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